scholarly journals Epileptiform Discharge and Electrographic Seizures during the Hypothermia Phase as Predictors of Rewarming Seizures in Children after Resuscitation

2020 ◽  
Vol 9 (7) ◽  
pp. 2151
Author(s):  
Jainn-Jim Lin ◽  
Mei-Hsin Hsu ◽  
Shao-Hsuan Hsia ◽  
Ying-Jui Lin ◽  
Huei-Shyong Wang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Therapeutic Hypothermia ◽  
Pediatric Patients ◽  
Epileptiform Activity ◽  
Pediatric Intensive Care ◽  
Nonconvulsive Seizures ◽  
Risk Patients ◽  
Electrographic Seizures ◽  
65 H

The aim of this study was to determine the frequency, timing, and predictors of rewarming seizures in a cohort of children undergoing therapeutic hypothermia after resuscitation. We retrospectively reviewed consecutive pediatric patients undergoing therapeutic hypothermia after resuscitation admitted to our pediatric intensive care unit between January 2000 and December 2019. Continuous electroencephalographic monitoring was performed during hypothermia (24 h for cardiac aetiologies and 72 h for asphyxial aetiologies), rewarming (72 h), and then an additional 12 h of normothermia. Thirty comatose children undergoing therapeutic hypothermia after resuscitation were enrolled, of whom 10 (33.3%) had rewarming seizures. Two (20%) of these patients had their first seizure during the rewarming phase. Four (40%) patients had electroclinical seizures, and six (60%) had nonconvulsive seizures. The median time from starting rewarming to the onset of rewarming seizures was 37.3 h (range 6 to 65 h). The patients with interictal epileptiform activity and electrographic seizures during the hypothermia phase were more likely to have rewarming seizures compared to those without interictal epileptiform activity or electrographic seizures (p = 0.019 and 0.019, respectively). Therefore, in high-risk patients, continuous electroencephalographic monitoring for a longer duration may help to detect rewarming seizures and guide clinical management.

Purulent Otitis Media—A “Silent” Source of Sepsis in the Pediatric Intensive Care Unit

1985 ◽  
Vol 93 (3) ◽  
pp. 330-334 ◽  
Author(s):  
Michael Persico ◽  
Geoffrey A. Barker ◽  
David P. Mitchell
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Middle Ear ◽  
Nasotracheal Intubation ◽  
Pediatric Intensive Care ◽  
Nasogastric Tubes ◽  
High Incidence ◽  
Risk Patients ◽  
Pediatric Icu

Septicemia is common in patients in the pediatric intensive care unit (ICU) who have nasotracheal tubes. Although it is frequently caused by middle ear effusion (MEE), pneumatic otoscopy is not routinely performed in these patients. To demonstrate the value of this procedure, 46 pediatric ICU patients with nasotracheal tubes were followed daily with pneumatic otoscopy for 11 to 98 days and compared with 25 controls without nasotracheal tubes, 12 of whom had nasogastric tubes. Myringotomy was performed whenever blood culture became positive. MEE was significantly more frequent in patients with nasotracheal tubes (87%) than in patients with controls (23%) and occurred first on the side of intubation. Blood bacteria were identical to middle ear pathogens in 80% of patients. Nasogastric tubes were not significant in causing MEE. The high incidence of MEE resulting from nasotracheal intubation indicates the importance of including pneumatic otoscopy in the daily examination of these high-risk patients.

scholarly journals Extracorporeal Membrane Oxygenation: The First 10 Years Experience of a Portuguese Pediatric Intensive Care Unit

2021 ◽  
Vol 34 (6) ◽  
pp. 435
Author(s):  
Daniel Meireles ◽  
Francisco Abecasis ◽  
Leonor Boto ◽  
Cristina Camilo ◽  
Miguel Abecasis ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Overall Survival ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Patients ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Pediatric Intensive Care ◽  
Overall Survival Rate ◽  
Clinical Complications

Introduction: In Portugal, extracorporeal membrane oxygenation (ECMO) is used in pediatric patients since 2010. The aim of this study was to describe the clinical characteristics of patients, indications, complications and mortality associated with the use of ECMO during the first 10-years of experience in the Pediatric Intensive Care Unit located in Centro Hospitalar Universitário Lisboa Norte.Material and Methods: Retrospective observational cohort study of all patients supported with ECMO in a Pediatric Intensive Care Unit, from the 1st of May 2010 up to 31st December 2019.Results: Sixty-five patients were included: 37 neonatal (≤ 28 days of age) and 28 pediatric patients (> 28 days). In neonatal cases, congenital diaphragmatic hernia was the main reason for ECMO (40% of neonatal patients and 23% of total). Among pediatric patients, respiratory distress was the leading indication for ECMO (47% of total). The median length of ECMO support was 12 days. Clinical complications were more frequent than mechanical complications (65% vs 35%). Among clinical complications, access site bleeding was the most prevalent with 38% of cases. The overall patient survival was 68% at the time of discharge (65% for neonatal and 71% for pediatric cases), while the overall survival rate in Extracorporeal Life Support Organization registry was 61%. The number of ECMO runs has been increasing since 2011, even though in a non-linear way (three cases in 2010 to 11 cases in 2019).Discussion: In the first 10 years we received patients from all over the country. Despite continuous technological developments, circuitrelated complications have a significant impact. The overall survival rate in the Pediatric Intensive Care Unit was not inferior to the one reported by the Extracorporeal Life Support Organization.Conclusion: The overall survival of our Pediatric Intensive Care Unit is not inferior to one reported by other international centers. Our experience showed the efficacy of the ECMO technique in a Portuguese centre.

scholarly journals Cefepime Pharmacokinetics in Critically Ill Pediatric Patients Receiving Continuous Renal Replacement Therapy

2019 ◽  
Vol 63 (4) ◽  
Author(s):  
Gideon Stitt ◽  
Jennifer Morris ◽  
Lindsay Schmees ◽  
Joseph Angelo ◽  
Ayse Akcan Arikan
Keyword(s):  
Intensive Care Unit ◽  
Body Weight ◽  
Intensive Care ◽  
Retrospective Study ◽  
Critically Ill ◽  
Pediatric Patients ◽  
Pediatric Intensive Care ◽  
Free Drug ◽  
Therapeutic Drug ◽  
Free Drug Concentration

ABSTRACT This retrospective study included pediatric intensive care unit patients receiving continuous veno-venous hemodiafiltration (CVVHDF) being treated with cefepime. The free drug concentration above one time the MIC (fT>1×MIC) and four times a presumed MIC (fT>4×MIC) of 8 μg/ml were calculated. Four patients received doses ranging from 48 to 64 mg/kg of body weight every 6 to 12 h. Three patients achieved 100% fT>1×MIC, with the fourth patient achieving 98% fT>1×MIC. Therapeutic drug monitoring should be considered for critically ill patients receiving cefepime on CVVHDF.

scholarly journals Clinical Factors Influencing End-of-Life Care in a Chinese Pediatric Intensive Care Unit: A Retrospective, post-hoc Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Yueniu Zhu ◽  
Xiaodong Zhu ◽  
Lili Xu ◽  
Mengyan Deng
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Patients ◽  
Pediatric Intensive Care ◽  
Clinical Factors ◽  
Factors Influencing ◽  
Previous Hospitalization ◽  
Underlying Diseases ◽  
Eol Care

Objective: End-of-life(EOL) care decision-making for infants and children is a painful experience. The study aimed to explore the clinical factors influencing the EOL care to withhold/withdraw life-sustaining treatment (WLST) in Chinese pediatric intensive care unit (PICU).Methods: A 14-year retrospective study (2006–2019) for pediatric patients who died in PICU was conducted. Based on the mode of death, patients were classified into WLST group (death after WLST) and fCPR group (death after full intervention, including cardiopulmonary resuscitation). Intergroup differences in the epidemiological and clinical factors were determined.Results: There were 715 patients enrolled in this study. Of these patients, 442 (61.8%) died after WLST and 273 (38.2%) died after fCPR. Patients with previous hospitalizations or those who had been transferred from other hospitals more frequently chose WLST than fCPR (both P < 0.01), and the mean PICU stay duration was significantly longer in the WLST group (P < 0.05). WLST patients were more frequently complicated with chronic underlying disease, especially tumor (P < 0.01). Sepsis, diarrhea, and cardiac attack (all P < 0.05) were more frequent causes of death in the fCPR group, whereas tumor as a direct cause of death was more frequently seen in the WLST group. Logistic regression analysis demonstrated that previous hospitalization and underlying diseases diagnosed before admission were strongly associated with EOL care with WLST decision (OR: 1.6; P < 0.05 and OR: 1.6; P < 0.01, respectively).Conclusions: Pediatric patients with previous hospitalization and underlying diseases diagnosed before admission were associated with the EOL care to WLST.

scholarly journals P0059 / #899: USE OF DEXMEDETOMIDINE IN PEDIATRIC PATIENTS AT THE PEDIATRIC INTENSIVE CARE UNIT OF THE NATIONAL INSTITUTE OF PEDIATRICS

2021 ◽  
Vol 22 (Supplement 1 3S) ◽  
pp. 63-63
Author(s):  
F.G. De Araujo De La Vega ◽  
S.L. Lizárraga-López ◽  
L. Diaz Garcia ◽  
P. Zárate Castañón
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Patients ◽  
Pediatric Intensive Care

The State of the Do-Not-Resuscitate Order in a Pediatric Intensive Care Unit in the Middle East: A Retrospective Study

2022 ◽  
pp. 082585972110732
Author(s):  
R. Sabouneh ◽  
Z. Lakissian ◽  
N. Hilal ◽  
R. Sharara-Chami
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Middle East ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Patients ◽  
Multiorgan Failure ◽  
Pediatric Intensive Care ◽  
Operative Management ◽  
Care Providers ◽  
Do Not Resuscitate

Objectives The Do-Not-Resuscitate (DNR) order is part of most hospitals’ policies on the process of making and communicating decisions about a patient's resuscitation status. Yet it has not become a part of our society's ritual of dying in the Middle East especially among children. Given the diversity of pediatric patients, the DNR order continues to represent a challenge to all parties involved in the care of children including the medical team and the family. Methods This was a retrospective review of the medical charts of patients who had died in the pediatric intensive care unit (PICU) of a tertiary academic institution in Beirut, Lebanon within the period of January 2012 and December 2017. Results Eighty-two charts were extracted, 79 were included in the analysis. Three were excluded as one patient had died in the Emergency Department (ED) and 2 charts were incomplete. Most patients were male, Lebanese, and from Muslim families. These patients clinically presented with primary cardiac and oncological diseases or were admitted from the ED with respiratory distress or from the operating room for post-operative management. The primary cause of death was multiorgan failure and cardiac arrest. Only 34% of families had agreed to a DNR order prior to death and 10% suggested “soft” resuscitation. Most discussions were held in the presence of the parents, the PICU team and the patient's primary physician. Conclusions The DNR order presents one of the most difficult challenges for all care providers involved, especially within a culturally conservative setting such as Lebanon. As the numbers suggest, it is difficult for parents to reach the decision to completely withhold resuscitative measures for pediatric patients, instead opting for “soft” resuscitations like administering epinephrine without chest compressions.

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